Lecture notes Contexts of Care (SSHN169)

SHN169 – Clinical Decision Making Process


Introduction to Clinical Decision Making:
Ways in which Decisions are Made

Aim
 To examine clinical decision making within nursing

Outcome
 To explore clinical judgements and clinical decision making.
 Identify factors contributing to the focus on clinical decision making.
 Identify the kinds of decisions nurses make.
 To begin to appreciate the difficulty of clinical decision making and sources of
information used to facilitate this.

Decision
 Origin – Late Middle English: from Latin decisio(n), from decidere determine
 “A conclusion or resolution reached after consideration”
 “The action or process of deciding something or of resolving a question”

Related Concepts
 Problem solving
 Critical Thinking – New publications 2018
 Clinical Reasoning
 Judgement
 Analysis
 Evaluation

Videos
 What is Critical Thinking – Tom Chatfield
o https://www.youtube.com/watch?v=-wgqq-
fwIKw&list=PLfW3Wp3x6cZT6eNuLokns-302o6kcBSwZ&index=1
 Ten Commandments for Critical Thinking
o https://www.youtube.com/watch?
v=svNTJp5pqKI&index=23&list=PLfW3Wp3x6cZT6eNuLokns-302o6kcBSwZ

Critical Thinking
 Applying knowledge from other areas
o Education, psychology, science & humanities
 Dealing with change in stressful situations
o e.g. Rapid decline of health; non-supportive significant others; unmotivated
clients
 Making important decisions
o e.g. Interpreting relevant research and information or data;
o knowing how to learn
o finding necessary resources
 Being able to be a “Critical Thinker” is so incredibly important to you as a practitioner
o it makes you better as a problem-solver and decision-maker.


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, SHN169 – Clinical Decision Making Process


 Critical thinking is what will make you able to “invent” * more effective ways of
delivering
care and promoting health.
o * Other inventive critical thinkers: Florence Nightingale, Henry Ford & Bill
Gates
 Mental Abilities with Critical Thinking
o Critical Analysis
 “Do I understand the patient’s problem or the client’s question?”
 “What are the underlying assumptions being made?”
 “Do I have enough knowledge and evidence to decide what to do?”
 “Is this belief, value or action that I am developing, the best it can
possibly be?”

Decisions and Problems
 What is Decision Making?
o “a process whereby appropriate alternatives are weighed and one is
ultimately selected.”
o Linked to problem solving
 Problem Solving is:
o “a process whereby a dilemma is identified and corrected.”
 See Sullivan and Decker, 2005
o

Decision Making
 In everyday life
o When we get up, get washed, get dressed
o Various cognitive processes some more complex than others, some
emotional, some practical
 In professional life
o Some ordering and automatic decisions
o More complexity requires different approaches
o Intuitive and analytical approaches (Hammond 1983)
 Analytical thought is slow, conscious, consistent and accurate
 Intuitive thought rapid unconscious data processing, combines
available information by “averaging” (Jasper, Rosser and Mooney,
2013)
 No single accepted theoretical or research based model of decision making
o Offredy, M. et al (2007)

Clinical Judgements and Decisions
 Clinical judgements and decisions are closely linked in nursing practice and are often
discussed as a single entity.
 E.g.:
o A nurse may notice that a patient’s breathing pattern has changed
(judgement) and consequently decide to call the doctor (decision)



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